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19 NEUROPATHIC PAIN: DEFINITION AND SCREENING
S8
Invited Presentations / Workshop – Basic Sciences 1 / European Journal of Pain 11(S1) (2007) S1–S57
questionnaires, based on the analysis of pain descriptors and neurological signs. Although none of the pain descriptor was specific by itself, these studies showed consistently that the combination of a relatively small number of items was sufficient to discriminate pain due to a definite neurological lesion. The fact that these different questionnaires, developed independently and in parallel in different countries, share a large number of items, strongly supports the validity of this approach. In this workshop we will address the potential applications of these new questionnaires both in daily practice and clinical research. The high diagnostic value of these questionnaires also suggests that they could be helpful for the definition of new operational diagnostic criteria for neuropathic pain. doi:10.1016/j.ejpain.2007.03.031
18 NEW SCREENING TOOLS FOR NEUROPATHIC PAIN: ARE THEY USEFUL FOR DAILY CLINICAL ROUTINE? R. Freynhagen Department of Anaesthesiology, Pain Clinic, Universitaetsklinikum Duesseldorf, Germany Although it is undeniable that accurate diagnosis is a milestone in choosing appropriate therapy, the main problem beside the lack of a world wide accepted definition of NeP is still the lack of a diagnostic gold standard. To prevent patients from a long pain carrer it is an important goal to assist primary-care physicians and non-pain specialists to identify patients with a NeP component. They have a key diagnostic position since they guide the therapeutic management from early on and have a pivotal role in triaging patients for specific treatment approaches. Much research has been undertaken in several countries to develop new tools for this purpose and surprisingly, although without any knowledge of each other, the different workinggroups choosed a similar approach to identify NeP with simple tools based on verbal pain description and neurological symptoms and signs (e.g. DN4, LANSS, NPQ, NPS, ID-Pain, PD-Q). In cooperation with the German Research Network on Neuropathic Pain we developed the painDETECT questionnaire, a reliable, simple and validated screening tool to predict the likelihood of a NeP component in chronic pain disorders. It can easily be applied fully by the patient and without any prior physical examination. It is the first tool to use unique pain patterns as a principal component and, while it incorporates radiation, it is particularly suitable for initial screening of mixed pain patients, such as low back pain. In this workshop we will
exemplary address the use of the PD-Q as one of the several available new questionnaires. doi:10.1016/j.ejpain.2007.03.032
19 NEUROPATHIC SCREENING T.S. Jensen
PAIN:
DEFINITION
AND
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Denmark Neuropathic pain can strictly be defined as pains due to a lesion or disease of the somatosensory system and accordingly a series of different conditions may give rise to a neuropathic pain picture. Common elements in neuropathic pain such as sensory deficit in the painful area, hypersensitivity phenomena in the painful area, aftersensations, gradual increase of pain following repetitive stimulation, and paroxysms of pain have raised the question whether these pains represent a clinical entity. According to some studies, neuropathic pain can be identified by simple screening tools, but other studies have questioned this notion. A major problem in the classification and grading of neuropathic pain is the lack of a specific diagnostic tool to diagnose these conditions, and some screening tools are subject to bias if the diagnostic instrument is used to define the condition. In certain pain conditions the symptoms and their underlying mechanisms may interact in an unpredictable fashion and add to the complexity of the clinical picture. This is particularly evident in mixed pain states. Screening tools have been shown to be useful in identifying neuropathic pain as a symptom with a reasonably high sensitivity and specificity. However, these tools can usually not distinguish one neuropathic pain condition from another. The underlying pathology of pain, which is an important element in classifying neuropathic pains will most likely influence both the choice of treatment and the prognosis of the condition, so a clinical assessment is always an important step in the work-up of patients with neuropathic pain. doi:10.1016/j.ejpain.2007.03.033
Workshop – Basic Sciences 1: ECTOPIC DISCHARGES IN C-NOCICEPTORS AS A CAUSE OF NEUROPATHIC PAIN
20 Workshop Summary: ECTOPIC DISCHARGES IN C-NOCICEPTORS AS A CAUSE OF NEUROPATHIC PAIN J. Serra
Invited Presentations / Workshop – Basic Sciences 1 / European Journal of Pain 11(S1) (2007) S1–S57
questionnaires, based on the analysis of pain descriptors and neurological signs. Although none of the pain descriptor was specific by itself, these studies showed consistently that the combination of a relatively small number of items was sufficient to discriminate pain due to a definite neurological lesion. The fact that these different questionnaires, developed independently and in parallel in different countries, share a large number of items, strongly supports the validity of this approach. In this workshop we will address the potential applications of these new questionnaires both in daily practice and clinical research. The high diagnostic value of these questionnaires also suggests that they could be helpful for the definition of new operational diagnostic criteria for neuropathic pain. doi:10.1016/j.ejpain.2007.03.031
18 NEW SCREENING TOOLS FOR NEUROPATHIC PAIN: ARE THEY USEFUL FOR DAILY CLINICAL ROUTINE? R. Freynhagen Department of Anaesthesiology, Pain Clinic, Universitaetsklinikum Duesseldorf, Germany Although it is undeniable that accurate diagnosis is a milestone in choosing appropriate therapy, the main problem beside the lack of a world wide accepted definition of NeP is still the lack of a diagnostic gold standard. To prevent patients from a long pain carrer it is an important goal to assist primary-care physicians and non-pain specialists to identify patients with a NeP component. They have a key diagnostic position since they guide the therapeutic management from early on and have a pivotal role in triaging patients for specific treatment approaches. Much research has been undertaken in several countries to develop new tools for this purpose and surprisingly, although without any knowledge of each other, the different workinggroups choosed a similar approach to identify NeP with simple tools based on verbal pain description and neurological symptoms and signs (e.g. DN4, LANSS, NPQ, NPS, ID-Pain, PD-Q). In cooperation with the German Research Network on Neuropathic Pain we developed the painDETECT questionnaire, a reliable, simple and validated screening tool to predict the likelihood of a NeP component in chronic pain disorders. It can easily be applied fully by the patient and without any prior physical examination. It is the first tool to use unique pain patterns as a principal component and, while it incorporates radiation, it is particularly suitable for initial screening of mixed pain patients, such as low back pain. In this workshop we will
exemplary address the use of the PD-Q as one of the several available new questionnaires. doi:10.1016/j.ejpain.2007.03.032
19 NEUROPATHIC SCREENING T.S. Jensen
PAIN:
DEFINITION
AND
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Denmark Neuropathic pain can strictly be defined as pains due to a lesion or disease of the somatosensory system and accordingly a series of different conditions may give rise to a neuropathic pain picture. Common elements in neuropathic pain such as sensory deficit in the painful area, hypersensitivity phenomena in the painful area, aftersensations, gradual increase of pain following repetitive stimulation, and paroxysms of pain have raised the question whether these pains represent a clinical entity. According to some studies, neuropathic pain can be identified by simple screening tools, but other studies have questioned this notion. A major problem in the classification and grading of neuropathic pain is the lack of a specific diagnostic tool to diagnose these conditions, and some screening tools are subject to bias if the diagnostic instrument is used to define the condition. In certain pain conditions the symptoms and their underlying mechanisms may interact in an unpredictable fashion and add to the complexity of the clinical picture. This is particularly evident in mixed pain states. Screening tools have been shown to be useful in identifying neuropathic pain as a symptom with a reasonably high sensitivity and specificity. However, these tools can usually not distinguish one neuropathic pain condition from another. The underlying pathology of pain, which is an important element in classifying neuropathic pains will most likely influence both the choice of treatment and the prognosis of the condition, so a clinical assessment is always an important step in the work-up of patients with neuropathic pain. doi:10.1016/j.ejpain.2007.03.033
Workshop – Basic Sciences 1: ECTOPIC DISCHARGES IN C-NOCICEPTORS AS A CAUSE OF NEUROPATHIC PAIN
20 Workshop Summary: ECTOPIC DISCHARGES IN C-NOCICEPTORS AS A CAUSE OF NEUROPATHIC PAIN J. Serra